The Devil Is In the Details

AngelBaby reached a new record last night: 106 degrees. We were expecting seizures or something, but he just sat quietly and ate tomatoes. Today he's much better, though TrophyHusband is now ailing. I'm importing my mother on a frequent flyer ticket tonight to take over from the saintly in-laws. I am spoiled, I know.

So: patient stories. The trouble with stupid patients is that they make me sad. You can't laugh with them, so if I'm laughing, I'm laughing at them.

Wacky patients are another story. I'll tell you about one of my favorite wackos, the Pirate. We call him that because he wears an big gold earring in one ear and has wild woolly hair, a fanciful mustache, and a dramatic limp. He can't read or write because he spent most of his childhood in juvenile detention. He's in his sixties, and his main health problem is diabetes.

A couple of months ago the Pirate showed up for his regular visit looking rather different. The earring was gone, the hair was tamed into a sort of pompadour, and his mustache was trimmed. I commented on his new look, and he said rather shyly, "I had to clean up, because I joined the church."

"The church!" I said. "What made you do that?"

"Well, my sister's been on me about it," he said. "And I know that if I don't repent before I die, I won't go to heaven. So I figured I might as well do it now."

I was a little disappointed to see the Pirate civilized, but he seemed happy.

A week ago he returned for his follow-up visit, still looking relatively spiffy. His blood sugar, on the other hand, was much too high.

"It must have been all the soda I drank today," he said.

"Must have been," I said. "How are things going at church, anyway?"

"Oh, it's going good," he said. "You know, at my church they talk in tongues."

"Really!"

"Yes, when you're feeling the Spirit, you start speaking in a language that only Jesus can understand. And I've been getting there. Yesterday I felt moved, and I went down on my knees, and pretty soon I started doing it -- I opened my mouth and all these sounds came out. But then I stopped. Afterward the preacher asked me if I stopped because my leg was hurting, and I said no, that wasn't it. And the preacher said, 'It was the Devil that made you stop. You were listening to the Devil.' And you know, he was right."

"How do you know?" I asked.

"Well, I was jib-jabbering away, feeling the presence of Jesus, when my mind just started to wander," he said. "It started to wander, and I fell silent, and all of a sudden I was thinking about ... soda!"

"That WAS the Devil!" I said.

Doctor's Holiday

I had my shoulder injected today, to treat biceps tendonitis brought on by hauling around the World’s Clingiest Toddler. I was a little nervous, but it didn’t even hurt, and afterward I felt like the Tin Man coming back to life.

I like to be a patient from time to time just to see what it’s like on the Other Side. Of course I don’t get to see things from a true patient perspective; I’m treated somewhat differently when people know I’m a doctor. You might be surprised to know, however, that the treatment is usually worse.

Not intentionally so, of course. See, when treating a fellow health care worker, everyone gets very kid-glovey and hyperconscious of everything they’re doing. So some slightly unpleasant things might not get done – rectal exams, say, or questions about substance use – and some unnecessary things – extra tests that do more harm than good – do. In addition, people tend to assume you know more than you really do. For instance, when I was doing the infertility thing, I missed some important instructions up front because everyone assumed I must know all about this stuff.

Whenever possible I hide the fact that I’m a physician. I got away with this for two days after I had my baby. The second afternoon, one of the aides came in looking a little odd, and finally said shyly, “We didn’t know you were a doctor – you’re so nice.” (Which made me feel good about myself but lousy about my profession.) But because I’d kept it secret, the nurses had felt free to give me very helpful instructions on how to care for my stitches and my baby, information that I might otherwise have missed out on.

Does this happen in other professions?

4

4 Jobs I've Had

I've had so many jobs in my life that I can think of twenty while hardly trying. I guess I'll list

4 Jobs for Which I Was the Least Prepared

1. Au pair in Switzerland. This was the summer I turned sixteen. I was reasonably good with kids; the main problem was, I didn't speak Swiss. Now, German, I spoke—and this was the motivation for doing the whole thing in the first place, to buff my German (that sounds kinky, doesn't it?). But Swiss is to German sort of what the heaviest Jamaican is to English. You know the movie The Harder They Come, how they're supposedly speaking in English but there are English subtitles? Swiss is kind of like that if you speak German. I think the kids thought I was a little slow. I ended up learning a lot of Swiss babytalk (also sounds vaguely kinky).
2. Cocktail waitress. I was bad at this not simply because of my dearth of physical assets, but because you don't make good tips from drunk people when you have a look on your face that says "Not only do you disgust me on a personal level, I find your choice of beverage risible."
3. Kaplan MCAT teacher. On paper, it looked like I should be good at this—I had made excellent use of the Kaplan materials and scored very well on my MCATs. In reality, I was hopeless. While I had used the written materials, I had never found the classes to be helpful, and I didn't see how they could help someone else much. Sitting in a classroom a couple of hours once a week was not going to change anyone's score. I was supposed to go through questions with the students, but I would typically read a question and say, "The answer is B, because ... because ... well, it's just obvious it's B, isn't it?" And they would stare at me, thinking, "Bitch." Mostly the students made me sad. They came to class carrying bottles of "Brain Power Amino Acids" and chewed their fingernails and asked me too many questions about their chances of admission to medical school.
4. Grand Rounds organizer. This is a duty that I managed to unload recently, thank god. It involved lining up speakers for our weekly educational conferences. It's a job for a schmoozer, which I am not.

4 Movies I Can Watch Over and Over

Hmm. I can't really watch any movie over and over. Here are some movies I've definitely watched from beginning to end twice:

1. Office Space
2. This Is Spinal Tap
3. The Matrix
4. 12 Monkeys

4 Places I've Lived

1. The hospital. I've never had my mail forwarded there, but sleeping someplace every third or fourth night for years adds up to some serious time.
2. With four different men. (No, serially, not all at once!) No one ever lived with me, because when I had my own places, they were aggressively mine—no room, no shelf space, no special chair for anyone else. After the third guy, I swore I'd never do it again; I loved my own space too much. Then I met my now-husband and weakened. I'm glad I did.
3. In a state of despair. Added up over the years, I'd say I've spent about ten to twenty percent of my life there. I do not plan to ever go back.
4. In a quasi-group house, when I was little. I say quasi because the house had more than one apartment, so it wasn't really communal living, except for the hangers-on and boyfriends my mom would occasionally collect. I loved it. I wish I could live that way now.

4 Places I've Been on Vacation

A long time ago I found a list in a travel magazine of The World's Top Ten Islands. I'm crazy for islands, so I saved it, and I plan to visit them all one day. (The list gets revised every year, but I'm committed to the one I saw first.) So far, I've managed to get to:

1. Kauai
2. Hawaii
3. Santorini
4. Puerto Rico (ok, not on the Top Ten list, but I think it should be)

It seems like a "four" meme should only have four categories. So I'll give in to my OCD impulses and stop here.

My Marathon, Part 3

Lesson 6: Remember to Read the Fine Print

The night before the marathon, I finally sat down with the information that had been mailed to me weeks before along with the number to pin on my shirt. I hadn't bothered to read it when it came because my friend was handling all the details. I hadn't bothered to read it when she dropped out because I didn't think I'd go. I hadn't bothered to read it when I decided again to go because—I don't know why. I was busy, ok? I was an intern on a call month, which meant that every fourth day I went to work in the morning and didn't come home again until I staggered out of the hospital in a sleep-deprived altered state the next evening. I had scheduled my day off to coincide with the day of the marathon, but that meant I was working right up until the night before.

When I did finally read the information, I found it rather confusing. Remember, I had never been in any kind of race before, and I didn't know any of the lingo, any of the routine. This was a smallish marathon, run by a charitable organization, and the logistics were clearly being handled by enthusiastic volunteers. There were pages and pages of information. Stuff about how to train, what to wear, what to eat. There was something in there about where to go if you wanted to catch the bus to the starting line, where to leave your bag of clothes, what time the race started, what time to meet the bus ... it made my fatigued head spin. So I tried to focus on the bottom line: where do I have to be, and at what time? I finally located that information. Then I went to bed.

The race didn't start at an absurdly early time, so the fact that it was an hour and a half drive wasn't too bad. I turned the radio on loud and sang along with Sarah Maclachlan and drank my coffee and cheered myself on. I arrived at the start with time to spare. It was a cool spring day. I pinned my number on my shirt, tied my car key to my shoe, tucked a couple of granola bars and a banana in the pocket of my jacket, and lined up with everyone else.

And we were off. People screamed and cheered. I felt happy and excited and proud, and not lonely at all.

My goal was simply to finish the marathon, and I knew that the best strategy for finishing was to run a negative split—that is, run the second half faster than the first half—and to do that, I needed to rein myself in for the beginning of the race, force myself to go as slowly as I could possibly stand. There were timer at each mile marker, and to begin I kept myself to a geriatric pace of 12 minute miles.

The first couple of miles went smoothly. I chatted with the folks running near me. I enjoyed the scenery—the race started in a remote area, and it was lovely.

Until. Until I started to notice an awful lot of cars going by with people leaning out of the windows and cheering people by name. Where were they going, I wondered? I trotted on for another mile or so, and it finally dawned on me. One of the things that the information packet had said was that this was a "point-to-point" race. I had thought that this was an odd thing to mention; unless they had figured out a way around the time-space continuum, of course the race was from one point to another. Weren't all races? But now it came clear to me that they meant point-to-point as opposed to a circle. That we would be starting and finishing in two different places. Two places that were, oh, 26.2 miles apart from each other. And that when I was done, I would be at Point B, and my car would be waiting for me waaay back at Point A.

That's what they'd meant by the taking of buses to the start thing. You could park at the finish and take a bus to the start if you didn't have someone to drive you. If you'd been abandoned, say, by a friend with a broken hip.

For the next mile I felt a little sick. How on earth was I going to get back to my car? It wasn't like this was a place you could cab to. This spot was probably marked on a map as Off the Beaten Path. And I'd already run five or six miles away from it.

Then I decided, fuck it. I'm here, and I am running this race, and I'm going to worry about getting back to my car when I've finished, and not until then. I ate a granola bar and kept on.

Lesson 7: Stick to Your Plan

The miles floated by. Eight, nine, ten. People stood at crossroads and clapped. I stuck to my plan. Running this slowly meant I had plenty of time for bathroom breaks (I took three) and food. I managed to clear my mind of everything and just sail on. Almost before I knew it, I had reached the halfway point, and I felt great. So I started to speed up. Each mile I went a little bit faster—11 minutes, 10 minutes, 9 minutes, 8 minutes. I passed one guy at about the 25 mile marker who muttered peevishly, "Where's the fire?" I wanted to say, "On my feets!"

And there it was: the finish line. I smiled for the photographer as I went under the banner. It had taken me four and a half hours, which meant that I averaged about 9 minute miles for the second half of the race. And I really, truly felt good. Heck, I felt like I could keep running.

Which was a good thing, because my day was far from over. There was still the little matter of my car waiting forlornly back at the starting line.

Lesson 8: Sometimes You Have to Ask for Help

I received my medal and t-shirt, and then asked the race volunteer who gave them to me, "So, is there by any chance a bus going back to the starting line?"

She stared at me as if I had just said "Is there by any chance a monkey climbing out of my ass?"

"A what?"

"A bus ... going back to the starting line ..." at this point I started to get very embarrassed, because clearly I was the only person in the history of running who had ever misunderstood directions. "My friend was supposed to drive me back, but she got hurt ..." I didn't lie, but I sort implied that my friend had dropped out that day, after the race started.

"Oh my god," the girl said. "No, there's no bus. Wow. You need to get back to the starting line?" You could see her tracing the 26.2 miles in her head. "Stay here," she said. "I'll see what I can do."

So I sat and waited. And waited. And got stiff. And got cold. And realized why people left bags of warm clothes at the finish.

Finally a woman appeared. "You need a ride back to the start?" she said. I repeated my pathetic half-truth.

"Well, I live sort of near there ... I can drop you off. But you'll have to wait until the end of the race."

Which is how I came to see all of the lame, halt, and old come over that finish line, as I sat and shivered, my knees tucked under my race T-shirt. Finally, finally the last person staggered across, the banners were rolled up, and I climbed into a rattly, rusty Datsun that smelled strongly of dog and drove forty-five minutes trying to make small talk with a saintly stranger who took me 15 miles out of her way. The sight of my little car sitting all alone in the vast parking lot made me shrink in embarrassment, but it was a welcome sight indeed.

At first my legs felt almost too stiff to work the clutch, but I cranked the heat and started to thaw a bit. At the main highway I found a McDonald's, where I got a cup of coffee and a fish sandwich. I ate while driving, and as I warmed up, the proud and happy realization came over me:

I had done it.

My Marathon, Part 2

Lesson 3: It’s Not a Great Idea to Run on a Belly Full of Cheese Fries, but It’s Not Impossible

Despite my misgivings, training for the marathon was really not too hard. We gradually increased our weekend runs until the final training run, which was supposed to be 20 miles but ended up being 24 because we didn’t check the distance carefully enough. Fortunately, there was a diner at the 12 mile mark. Unfortunately, I lost all control and scarfed down cheese fries and a chocolate milk shake. I came to regret this on the slow trot home because I had to taste them the whole time as I belched away, but I managed. We walked the last few miles, but I really felt pretty good.

My training partner, on the other hand, did not.

Lesson 4: Don’t Overdo It

On the last training run, my partner came up lame. At first she tried to hide it, but pretty soon she was swaying like a peg-legged sailor, and I said, “Er, don’t you think you should see a doctor about that?” She finally agreed. We still had a couple of weeks until the marathon.

You see, my running partner had started running relatively recently. Although she was running about as much as I when we started, she had only been doing it a few months. She didn’t have a deep base upon which to train.

Which is how she developed a STRESS FRACTURE of her frickin’ HIP. And was ordered to put no weight on her leg for three MONTHS.

I felt really bad for her, but I have to confess, I felt a little annoyed, too. This whole thing had been her idea; she had researched it, and she knew that she was pushing it. Also, it was her friends and family who were supposed to drive us to the race, which was an hour an a half away. Once she dropped out, she wasn't interested in even going, and they weren’t interested in driving me. Which I guess is understandable, but it made me feel a bit abandoned. I’m still not sure if I should have felt that way, but I think that if I were in their shoes, I would have at least offered. I asked around, but not surprisingly, I couldn't find anyone who was a) free that day and b) willing to spend the whole day at a marathon for me.

So, I decided I wouldn’t go.

Lesson 5: Don’t Be Such A Wuss

After a week or so of feeling sorry for myself (and a little guilty about feeling sorry for myself when my friend had a BROKEN HIP), I realized that I shouldn’t waste all the training. I knew I’d regret it every time someone asked yet again, “You run? Did you ever do a marathon?”

So, I decided I would go by myself.

To be concluded.

My Marathon, Part 1

I managed to reach my twelfth year of running without every entering so much as a local road race. This was partly due to the fact that I don’t enjoy running in crowds, but mainly because I hate to run in the morning, and just about every race takes place at an ungodly early hour. But whenever people find out that you’re a runner, the most common next question is, “Have you run a marathon?” This gets tiresome after awhile if in fact you have not. So when an acquaintance started bugging me to train for a marathon with her during my internship year, I eventually agreed.

Internship year of residency is not thought to be an ideal time to be doing something so time-consuming as training for a marathon; the job itself sucks up most of your free time. But I was already running a fair amount. I found it to be an ideal stress-reliever, and something I could do almost no matter how late I got home. I also used it to explore my new city. (Which worked well, except that I would then drastically underestimate how long it might take to walk someplace, resulting in a few annoyed acquaintances who just wanted to go out for a beer, dammit, not walk all the hell over Creation.) It didn’t seem like such a stretch to put a longer run in on my one day off a week. So I agreed, although secretly at first even I wondered if I would really follow through.

I’m a sucker for birth stories – funny, overdue, traumatic, last-minute – yet I don’t think my own is particularly interesting or enlightening.* But I do feel like I learned a lot from my marathon.

Lesson 1: I Accept that I Am Powerless Over Candy

I have had a bad candy habit since childhood. Not candy as in chocolate (which I consider food, not candy); candy as in as close to straight sugar as possible. I had to have it available at all times. It got me through many stressful periods in my life – like, say, internship. I didn't feel safe unless I had a stash in my pocket, like some starving beggar child from Dickens. I never hit the stuff before lunch, but from then on out was happy hour. I ruined my teeth. I didn’t get fat, but that was because I substituted candy for real food.

After about a month or so of training, I realized that I needed to improve my diet if I was really going to do a marathon. When I forced myself to think about it, probably half of my calories were in the form of refined sugar. But I knew I couldn’t cut down. I’d tried that before. No, I’d have to go cold turkey.

I set a quit date, finished the stuff I had lying around, and steeled myself.

It was baaaad. In the beginning, I thought about candy near-constantly. I was twitchy as a gerbil with Tourette’s. I had to take a circuitous route through the hospital to avoid the gift shop, where I often used to get a fix. I couldn’t go to drugstores either, which was inconvenient when I ran out of antiperspirant. But I did find that I suddenly had an appetite for real food again. And gradually, as the weeks went by, I thought about it less and less, and then hardly ever. It felt so freeing, not to have the shame anymore. And as a bonus, I became much more sympathetic toward people who had a hard time quitting smoking.

Lesson 2: I Can Make Friends When Forced To

The person who invited me to train with her was a resident in a different specialty. My initial impression of her had been slightly negative – she seemed a little, I don’t know, rigid? Unforgiving of faults in others? But running with someone is like taking a long car trip; it’s enforced togetherness, and conversation eventually happens. So it was that I learned that we had a great deal in common. Similar off-kilter type of upbringing; similar circuitous route to medical school; similar interest in the arts. She was even born the same week of the same year that I was. Soon we were hanging out all the time, talking on the phone, shopping. It was like the pictures I used to pore over in Seventeen magazine when I was thirteen and just wanted to be normal.

To be continued.

*It can be told pretty well in a single paragraph:
Water breaks at midnight. Husband freaks out despite being a doctor. Hospital, pitocin, epidural, blah blah blah. Weather channel on TV. Phone calls to wrap up loose ends at work. Sneaking a cappucino. Getting bored. Finally pushing and PUSHING and pushing and PUSHING. Baby’s heart rate dipping. Vacuum forceps, aka Baby Head Plunger, after 21 hours. Baby fine; unutterable relief. Embarrassed re: unable to birth 5 lb 14 oz baby without assistance (his head was big, I swear). Many many many stitches. The End.

Letting It Go

A little while ago I made a promise that I'm going to break.

I am not going back to the fertility clinic. No more tests.

I'm done.

Not necessarily done as in no second child ever, but done as in no needles in my ass again ever.

And it feels like a great weight off my shoulders.

I've been circling around this realization for a long time, without being able to see it clearly. If I'd really wanted to go the ART route again, I should have been back at the clinic a year ago, and I knew that. But something kept me from saying aloud that I didn't want to.

Partly it's that saying I didn't want to go through it all again feels like saying that my son wasn't worth it, which is of course not true — I would certainly do it all again, knowing I'd have him at the end. But doing it all again not knowing how it will end — and it could easily end in heartbreak — is something quite different. And doing it all again with him here is also different. I have realized that the question of what to do next is interfering with my enjoyment of the baby I have. When he's being adorable, I'm thinking in the back of my mind, this will be hard to enjoy when I'm distracted by treatments, or even when I'm distracted with a newborn. And when he's being hellacious, I'm thinking, how can I possibly manage treatment and him, or even two like him? It makes the good times feel watered down and the hard times more difficult.

It's also hard for me to admit that I can't handle much more than I have on my plate right now. It's not like my life is so tough — my job could be a lot harder, I could have a husband who doesn't split the home stuff fifty-fifty, we're all healthy — yet I'm not sure I could cope gracefully with much more. I've always had a problem admitting anything is too hard — I've got pride issues. And it seems somehow wrong to say that it's too hard to try for another baby; in an ideal world, I would like another, so if I can't do whatever it takes to have one, I must be weak.

As long as I'm admitting hard truths, I have to say that I don't find caring for a baby to be especially fulfilling. I adore my son, and somewhat to my surprise I love sleeping with him and breastfeeding him and singing to him and carrying him around. But I love when he heads off to daycare and I head to work, too. I don't daydream about staying at home with several kids — for me that would be more of a nightmare. When I am sleep-deprived and bored and isolated, I get depressed, and I don't mean down, I mean clinically depressed. Of course I wouldn't have to stay home if we had another baby, but I would certainly be more home-bound. I know this would be temporary, and it's hard to weigh a temporary bad thing against a possible permanent good thing. But then again, now is all I've got. I always tell my students, you have to decide what you want to do based on what you like doing every day. You won't find your joy by being miserable every day, even if you're working toward a goal you think will probably be wonderful.

Life is pretty wonderful right now as it is, and it's time to let all this go and just be here.

Feels good.

At Least I Brought Donuts

I was sorely, sorely tested this weekend.

Please note that I said I "will do my best to be as positive, helpful, and ungrumpy as I can be" — whole lotta wiggle room there. And wiggle I did, because man oh man, did I get it from every angle. Some highlights:

• Page at 9 pm, while at a party, with HellBoy clinging to my leg and weeping: "My husband saw Dr. Z the other day for a cough and stuffy head and a low-grade fever, and I'm not sure he's getting better as fast as he should ... he coughs a little more at night but also during the day and his temperature is 99.8 and his nose is stuffy, not clogged stuffy but hard to breathe a little but it's a little better if he takes decongestant but not all the way better and his throat hurt but it doesn't anymore and ..." I finally got her to stop and told her it sounded like they were doing all the right things, and she says, "That's what Dr. Z said too — here, I'll have him tell you!" Before I could say "Oh, I don't think that's necessary!" her husband got on and said, "I saw Dr. Z the other day for a cough and stuffy head and a low-grade fever, and I'm not sure I'm getting better as fast as I should ... I cough a little more at night but also during the day and my temperature is 99.8 and my nose is stuffy, not clogged stuffy but hard to breathe a little but it's a little better if I takes decongestant but not all the way better and my throat hurt but it doesn't anymore and ..." At which point I cracked and said, "I'm sorry, but I have a crying baby here and I'll have to go, sounds like you're doing ALL THE RIGHT THINGS! BYE NOW!"

• Page at 9:30 pm, still at the party,* HB now with his dad in the other room howling "Mama! Mama!": "I'm a patient of Dr. C's, and he told me I shouldn't go to the emergency room anymore, because I could just pick up an infection there. But tonight I have a headache. Do you think I should go to the ER?"
  

• Page at 10 pm: "I just took a shower? And I'm itching? You know, down there? It's the same soap I always use and I don't notice any discharge? And ..." I closed my eyes, remembered my resolution, and sweetly suggested she go the drugstore to get something over the counter.

• Page at 10:30 pm: "I'm here in the drugstore? And I notice that it says on the box to ask your doctor if you're pregnant? And I'm not pregnant, but we're trying? And ..." I admit I was much less sweet on the second call.

• Page at 4 am: "I've been having pain in my shoulder for weeks and I saw the doctor and all she gave me was 20 Perc0cets. Now how am I supposed to deal with pain like this if they only give me 20 Perc0cets? I went to the ER and they gave me ibuprofen. That's like taking nothing. I want you to do something about this pain." "Well, I'm just the doctor on call for emergencies, and I'm afraid I can't do much for you because I'm HOME IN BED." Which is always the wrong thing to say. She said, "Well, I'm sorry I woke you up, but I'm awake too, because I'm IN PAIN." When I told her I wouldn't prescribe narcotics over the phone at night she said, "Well you doctors just all stick together, don't you?" and slammed down the phone.

Then I got twice the usual number of patients dumped on me to cover at the hospital, which wouldn't have been too awful except that the damn pager Would. Not. Stop. Beeping. I think every nursing home resident in the state slid out of their wheelchair this past weekend, and the staff was required to report every single one to me. The poor house staff got essentially no help from me, and heard a lot of bitching and moaning.

But they did get donuts.


*Yes, we tried to go to a party while I was on call, and we took HB with us, and kept him up past his bedtime. I know, what was I thinking? Well, what I was thinking was, god dammit, I never get a chance to go to parties, and I don't want to leave HB with a babysitter when I won't see him during the day the whole weekend. He did take a late nap, which we figured would hold him over. And in fact it did — he refused to go to sleep until midnight. It was a fun party, or so TrophyHusband told me later. I spent most of it on the phone.

I Am An Asshole

My colleague who announced her pregnancy last month had an ultrasound that revealed no heartbeat. She's scheduled for a D&E next week.

Now I feel really rotten about feeling jealous. And when she told me about it, she said, "People are asking if I'm going to try again, but I don't think so ... this got me thinking about how shaky my marriage is, and how much easier it's gotten for me since my son is getting a little older. It would be so hard to go through the early part again." She has a chronic and painful medical condition, but she does basically everything around the house. She asked her husband to put their son to bed the night after the ultrasound, since she was feeling pretty low, and he refused. To top it off, he wanted to have sex. (She declined.)

Then one of my other colleagues, Z, who's done several unsuccessful IVF cycles, overheard a medical student receive news that her father died. Z didn't really know the student, but she was worried about her driving the hour and a half to get to her family's, so Z cancelled her Valentine's plans with her husband so that she could drive the student home.

Now our wonderful friend E is going to spend part of her precious free day tomorrow babysitting for HellBoy, who is febrile and coughing and can't go to daycare. (E discovered this blog and was worried that I might feel like I can't complain about her here. AS IF.)

Basically, this is making it clear to me that I'm a selfish asshole.

I resolve to turn over a new leaf. No more Schadenfreude for me. I'm on call this weekend and rounding in the hospital and will do my best to be as positive, helpful, and ungrumpy as I can be to everyone I see.

Maybe I'll even bring donuts.

The Club

Before I became a mother, I assumed that once I had a baby, I would be magically inducted into the Motherhood Club, complete with ID badge, secret handshake, and most important, invitations to play dates. It seemed like all of my acquaintances who had children participated in these mysterious activities. Once I was a mother, I too would have a huge circle of friends!

HellBoy arrived, and I waited with anticipation. Would the invitation come by mail? Or would there be a sudden knock on my door?

Maybe word got out about HellBoy’s hellishness, or about my social ineptitude, or both. Whatever it was, I was never invited into the Club. To be honest, I didn’t mind too much, because I never liked the uniform. But! Not long ago I (or rather we) did receive an invitation to our very first Play Date, from the parents of a little girl who is a classmate of HB’s.

I was excited and nervous. What to wear? Should we bring something? If so, what? Wine? Flowers? Toys? Were we supposed to arrive at the stated time, or fashionably late? (TrophyHusband and I can never get the timing right for attending social events. We never arrive earlier than the appointed time, but we’re commonly the first people there by half an hour or more, and have startled hosts in their sweatpants on more than one occasion. The one time we were inexcusably late, to a party given by my boss, I arrived with profuse apologies on my lips only to discover that for the first and only time we had timed it exactly right.)

Eventually we decided not to bring a gift, because in addition to being too busy/lazy, we reasoned that if this Play Date thing became a tradition, we didn’t want to be obligated to do it every time. We arrived 15 minutes past the scheduled time; hard to tell if this was okay or not, because we were the only guests. Nobody was in sweatpants or looked startled, at least.

We said our hellos (Smile! Look them in the eye! Ask how they are! Admire the house!) and were led inside, where I was pleased to see treats laid out on the dining room table. Oh good, I thought, we get to eat!

But no. We were led past the food and up the stairs. TH and I eyed each other. Where are we going? I mouthed. But he shrugged, at as much of a loss as I.

At the second floor landing, we paused, and I thought Oh, maybe we’re taking the tour of the house? I admired their baby’s room. HB ran the other way, into the master bedroom, which didn’t seem to alarm anyone unduly until he scampered around to the other side of their bed and located their lube and condoms, which he snatched up and brandished with glee.

Once the sex supplies were traded for a toy, we continued up another set of stairs to the top floor of the house, which turned out to be the playroom, and we finally understood that we were all to sit around and play. This disappointed me greatly, because I had hoped that we would all sit around and eat goodies and perhaps drink wine, and let the children play. This setup was beginning to look like work.

Then another slightly uncomfortable situation arose. It turned out that the little girl’s father was German, and spoke to the child in German. The uncomfortable part about this is that I speak German too (most useless language ever taught, by the way), and I wasn’t sure what to do to let him know that I could understand what they were saying. Announcing “I speak German too!” seemed unacceptably geeky. Simply breaking into German myself seemed unacceptably snobby (and besides, my German is way rusty, and there was a risk I’d say something unintended, like “I love your sex lube” instead of “I love your playroom”). Eavesdropping while not saying anything seem unacceptably sneaky. (Not that they were talking state secrets; it was just the usual “Up! Up!” “Do you want Daddy to pick you up?”) In the end I just tried to have a comprehending look on my face. Later TH said, “That was really weird that you didn’t say anything about speaking German!” Sigh.

So we all played and made stiff small talk. At one point HB insisted that we all hold hands in a circle and dance, which maybe some people can pull off without feeling idiotic, but I am not one of them. We were finally released when HB figured out how to turn on their stereo and crank the volume to 11 and insisted that this was the only thing he wanted to do for the rest of his life and how could we be so cruel as to refuse it?

So back down the stairs we went, and were finally allowed to have at the snacks. Which were very fancy. No wine, unfortunately, but good coffee. The small talk did loosen up a tad. It was a little hard to concentrate, though, because their house was very nice, much nicer than ours, and I was terribly nervous that HB would use his sippy cup as a cudgel and mar their (responsibly harvested) tropical hardwood table. Nothing of the kind occurring, we decided to get while the getting was good, and said our goodbyes.

I think that this was a relatively successful event. I’m sure I’m overanalyzing it, it being the first play date I’ve ever been invited to and all. I do wonder if the hosts had to report back to the Club on my behavior, and if so, will I be invited in after all?

I sure hope there's no hazing.

To the Bedside Manner Born

A friend mentioned to me recently that she's thought about going to medical school, but believes she wouldn't have the necessary bedside manner. I think she was referring to the fact that she's a little shy — she's certainly not rude, though she is wicked funny — and I realized that the things that are predictive of a good bedside manner aren't exactly intuitive.

For instance, a good schmoozer is not necessarily good with patients. I myself have never been able to schmooze properly. Part of this is the way I was raised; my mother never taught us many of the standard social niceties, like introducing oneself, saying hello and goodbye, shaking hands. (Truly, we didn't say hello or goodbye in my family. People are often startled by the way my mother will just get up and walk away.) I can shoot the shit with people I already know, but when I first meet someone, I have to keep reminding myself, Now you say hello and smile. Ask how they're doing. Maintain eye contact. I said maintain eye contact! It can be exhausting. (I find that meeting fellow bloggers is less of a strain, I think because I feel like I already know them.) But give me a patient to talk to, and I'm better than Oprah. Because a good doctor doesn't talk; a good doctor listens while the patient talks. I am the Queen of the Pregnant Pause. It's a rare person who can stand a silence longer than I can. On a blind date, this is death, but in an exam room, it's pure gold. And by the time it's my turn to talk and try to explain something or sell the patient on my plan, the ice is long since broken.

This may come as a shock, but in general, the people who are attracted to medicine as a profession are not the social superstars. Doctors tend toward shy and quiet; they're the sort of people who are more interested in observing others than being the center of attention. And I have often noticed that the way doctors behave socially is rarely the way they behave in front of patients. Which is a good thing, because I've met some real wackos. I am a real wacko. But I can say: "What brings you here today?" and then shut my trap. (And no, nobody ever answers "the bus.")

Of course, there are some schmoozy types who go into medicine. We call them "surgeons." I'm kidding, but only a little. We attendings amuse ourselves when meeting new medical students by trying to predict each student's future career path. Schmoozy, hail-fellow-well-met men: Surgery. Assertive women: OB/Gyn. Geeky shy cerebral types: Internal Medicine. Sweet happy types: Pediatrics. Crunchy happy types: Family Medicine. Intense oddballs: Psychiatry.

I have a meeting with each student halfway through the clerkship so that I can get their impressions of how it's going and give them feedback on what the residents and attending are too chicken to tell them to their faces. (I keep a box of tissues handy.) There are really only about three scripts that I have to remember, because there are themes that recur. One of the most common is the Shy Student. The problem with the Shy Student is almost never bedside manner; it's the interaction with the other members of the team. If you don't speak up, people think you don't know anything, but what's worse is, your good ideas about and knowledge of your patients go to waste. I myself got the Shy Student talk my first month on clinical rotations as a med student. The attending said, "I'm giving you a High Pass for this month instead of Honors, because you haven't spoken up enough." I have to say, I was furious. I thought it was ridiculously unfair. I mean, it was OBVIOUS that I knew more than the other medical students! Wasn't it? Er, maybe it wasn't. So I started being Mouthy Student, or as mouthy as I could be. And it worked: I never got anything but Honors ever again. What I tell students to do is: pretend you're someone else, someone you think is a bit of a loudmouth grade-grubber. No matter how hard you try, you won't really become one, but you'll definitely crawl out of your shell a little ways, and it's not as painful as you think.

So if all that's preventing you from applying to medical school is your quasi-Asperger's personality, I say go for it.

Five Medical Myths

Five medical myths I wish would die a horrible death:

1. Green mucus = go to the doctor. NOT TRUE. Somewhere, somehow, someone started the myth that while it's ok to have clear or white snot or phlegm, green snot is an ominous sign, and means that you must seek medical attention, quick! In fact, any run-of-the-mill respiratory virus can produce a whole palette of lovely snot shades, from palest ivory to pea-soup green. This has been studied; color of sputum has never been shown to indicate whether an infection is viral or bacterial. (And the vast, vast majority of illnesses that cause you to cough up nasty greenies are viral.) There is a type of pneumonia that can cause rust-colored sputum, but we don't see this much, and in those cases the sputum alone is not the only clue as to what's going on. Yet doctors keep on asking patients about the hue of their snot, and every magazine article about respiratory infections says, "you don't need to see the doctor unless you have green phlegm."
   
   
2. "It's just a virus." And its corollary, "you don't need antibiotics." NOT TRUE. Patients get frustrated when they go to the doctor feeling lousy and are told the above, and they should; they're really sick, and they shouldn't be told they're not. Viruses are bad; viruses can kill you, or at least make you wish you were dead. We don't give antibiotics for them because the antibiotics we have, with the exception of a couple of flu medicines, don't work on viruses, not because you don't "need" them. Believe me, if and when an anti-cold virus antibiotic is developed, we will be using it. (Of course, you won't have to take these hypothetical antibiotics, but then, you don't have to take antibiotics for bacterial infections, either. Yes, you can survive many bacterial infections without antibiotics.)
   
   
3. High blood pressure gives you headaches. NOT TRUE. Studies such as this, this and this have repeatedly shown that this is not true, yet patients and doctors continue to believe it. The problem with this is twofold: patients may assume that if they don't have a headache, their blood pressure must be ok, and patients don't get their headaches adequately treated.
   
   
4. Drinking lots of water is good for you. NOT TRUE. This one really gives me a headache. I think it started because of a misunderstood study long ago that the average amount of water a person uses for the business of existing for 24 hours is equal to about 8 eight-ounce glasses of water. The misunderstanding is that this is not EXTRA water; it's the water that already exists in all the foods and beverages a person takes in during the day. Thirst is actually a wonderful mechanism for telling you how much water you need. Extra water does not benefit you. It doesn't help constipation, it doesn't help your skin, it doesn't benefit your kidneys (unless you have kidney stones), it doesn't help you exercise. Perhaps it helps some people avoid eating and drinking a lot of fattening junk, but this is questionable. What it DOES do is make you pee constantly, and in severe instances can actually kill you. If you're truly dehydrated, you don't need water, you need water plus electrolytes. The water myth is reprinted in every issue of every health and beauty magazine published, so I have little hope of it dying.
   
   
5. Coffee is bad for you. NOT TRUE. People have been trying to prove this for decades, and they haven't been able to do it convincingly. (Which means that there have probably been a lot of unpublished studies that showed no harm.) In fact, there's evidence that coffee may be good for you. Now, plenty of people don't tolerate caffeine well, but for those who do, drink up!

Any myths in your field that you'd like to put to death?

Shopping with Rose-Colored Lenses

I had another dentist appointment today. My upper teeth look human again, so that I can now toss my head back and laugh affectedly the way they do in bad commercials. I pre-medicated a bit for the visit (HATE going to the dentist), and then it went a little faster than expected, so I left feeling a liiiittle too good to get in the car and drive immediately. But hey, look — shops right near the dentist! With lots of pretty things to buy! And no HellBoy to distract me with his pesky screaming and thrashing.

It wasn't till I got home that I realized that everything I bought is PINK. Pink sweater, pink tank top, pink underwear, even some fuzzy pink flipflops. I almost bought a pink purse, but I didn't really like the shape, thank heavens. I must have increased the number of pink items in my closet by 500% today. Note to self: no more shopping under the influence. At least it was all on serious sale.

I still haven't made an appointment with my RE, but I will, I promise. I wonder, if my ovaries are indeed little dried-up husks, will I be devastated? Or will I be slightly relieved that I won't ever undergo another fertility procedure? I'm honestly not sure. But I agree, it's time.

At any rate, all of your comments definitely helped make me feel 1. appreciative about all that I have and 2. less embarrassed about feeling jealous.

I've been thinking about one of the comments that Bihari wrote:

I have several friends who are trying hard for children right now, and I really want to be a good friend to them through this, even though I have Mother Of Two stamped across my forehead. Any suggestions? I usually have just been keeping in mind that we all have our own set of losses and disappointments, and even if they're different, the experience of living through loss and disappointment per se can be the same, so that gives us a lot of common ground. But I could be full of shit. What say you?

Full of shit? Definitely not. In fact that's how I make myself feel better about someone else's fortuitous fertility: would I want her life? Everyone has some hard things to deal with. OK, this approach doesn't always work — there's one person in particular I know who has NEVER had ANYTHING go wrong in her entire life, in fact has had all sorts of wonderful things happen, and although she's a very nice person, I can't help it, I'm not a big enough person to be able to get past it. I know that people probably think that I've had it easy, too — I've got a great job and a TrophyHusband, we don't have to worry so much about money anymore, I've got a healthy baby. I even like my inlaws. Hell, I'm starting to irritate myself. But I have had some pretty crappy things happen to me in the past; I know what it's like to feel as if nothing will ever go right. And I think that loss and disappointment do indeed give you common ground.

As for specifics about talking to someone who's struggling with infertility when you yourself drop eggs like a hen and can get pregnant by shaking hands? Midwestern Deadbeat mentioned that she'd read Tertia's piece on how to be good friends with an infertile, and I think it is good advice. I myself was not/am not an especially touchy or bitter infertile (I think. Others may beg to differ). I've had worse things happen to me than infertility, and my experience was about a tenth as bad as some — it was only a few years of trying, I didn't have to do THAT many cycles of IVF, a lot of it was covered by insurance, and I didn't have any wrenching pregnancy losses, just one miscarriage of a "chemical" pregnancy — so I don't feel I'm able to speak for Infertiles in general. But I do have two pieces of counsel:

First, if someone is undergoing treatment, try not to take their bitchiness and/or craziness personally; it's not about you, and it will pass. Because those hormones make a person insane. I was never a PMS-er, and figured, how bad could ART be? Answer: really, REALLY bad. There were times when I would walk around in a white-hot rage for a week. I locked myself in a room during one vacation at my in-laws because I couldn't trust myself not to say something that would ruin my relationship with them forever. Seriously. TH had to bring me meals.

Second, there's a magic phrase that is always appropriate and that is guaranteed, if not to make an infertile person feel better, at least to not do harm: "You're handling this amazingly well." TH must have said that to me a thousand times, and while I sometimes doubted whether it was true, it always made me feel at least a tiny bit less psychotic. (Turns out it really wasn't true. Poor TH.)

It's Not Like My Toes Are Even Pretty

I have heard about three pregnancies in the last 24 hours. First, Angelina. Next, one of my students who wanted to explain why she's been MIA for some required exercises (she was vomiting in various bathrooms around the hospital, poor thing). Finally, one of my colleagues.

I have long noticed that some pregnancy announcements make me wince a little, and some do not. Angelina's, now, I feel irrationally happy over, maybe just because it's cool to think of two such gorgeous people combining genes, and maybe because she's certainly paid some dues (albeit with a fat checkbook). My student's, well, a tiny bit. Because I didn't have a guy who was willing to undertake parenthood with me at that stage in my life, even though I was already getting slightly long in the tooth (and I knew I couldn't do it alone).

My colleague's announcement was pretty hard to take. She's my age, and she sees outpatients in the same office as I do. She got married when I was in year three of my fertility quest, and she wasn't worried in the least about whether she could get pregnant — she used birth control for a while, even. Then of course she got pregnant two weeks after I finally did. (Which meant that we were out on maternity leave at almost exactly the same time, which just about shut down the practice — despite ample advance notice, none of the higher ups seemed to grasp what kind of problem this would be — but I digress). Recently I asked her if she thought she wanted another, and she said, maybe, sort of ... then she stopped her birth control again and had sex exactly ONCE, and now she's pregnant again.

I hate this evil finger of jealousy scratching at my back. I don't begrudge her this pregnancy, and I know she has a lot more to deal with than I do in life — she has a chronic medical condition that leaves her in pain and fatigued, her husband does almost nothing to help with their son or the house, and she's a really kind, generous person who has helped me often. And, I already have a fantastic (though hell-bent) baby myself, which a lot of people probably begrudge me. But it's hard to shake this ugly feeling. Jo wrote about it much more eloquently than I a little while ago.

It also makes me do something I hate to do, which is face up to my own desires and motivations. I have not made an appointment with my RE, despite knowing full well that time may have run out for me. I have not weaned HellBoy, despite knowing full well that nursing is probably interfering with any chance at fertility I might otherwise have. I become very adolescent about the whole issue. I'm still pissed off that I don't have the luxury of deciding how many biological children I want. I want to be able to ponder when would be a good time to have a second baby, without the incessant noise of the clock winding down making it hard to think. I'm finding this whole gig pretty overwhelming at times, and the thought of adding another baby to the mix sometimes seems outrageous. Not to mention the hideousness of infertility treatment. It would be nice to know that I could wait a couple more years to catch my breath.

I have a slightly ridiculous reason for wanting a second biological child: HellBoy looks almost nothing like me. He's got exact replicas of his father's cleft chin, distinctive nose, big brown eyes, even his long flat feet. The things that may have come from me are all pretty generic — straight fine hair, smallness, maybe his mouth? Probably his eyebrows? I mean, we're grasping at straws here. I joke sometimes that at the IVF center they finally got fed up working with my tough old eggs and just borrowed one from a nice young woman who resembled me. There's no easy way to prove this isn't true.* I coached my cousin's wife at the birth of their first child, and I was the first person to hold and dress the baby. I noticed right away that she had my cousin's toes, which are unmistakeable, and which I also have (maybe I'll post a picture sometime, but for now you'll have to trust me, these toes are better than DNA testing for tracking family connections). And I thought that was the coolest thing.

I want a baby with my toes.

So that's a pretty stupid reason, and yes, I realize that even if I had a second biological child it could be mini-TrophyHusband #2. I need to appreciate my incredibly good fortune in having HB at all (which I do, I do). I need to decide whether I want to get my butt to my RE and let them tell me if the door is really closed, because until I know that it's all rhetorical anyway. And then I probably need to wait a little while and talk some more with TH about what would be the best adoption scenario for us.

OK. Enough about me and my whining. Let's talk about lurkers, shall we? Because for de-lurking week, this blog is kind of a bust. Hundreds and hundreds of you, yet only one de-lurker ... why so shy? (You still out there, E?) Well, really, I'm not going to harangue anyone. I always hated my creative writing workshops where we were required to make comments. Some stuff was just crap, and the less said about it the better, and some days I felt like crap and didn't think I should impose that on the author either.

So forget I even brought it up. Carry on.

*No, of course I don't really believe this. Because they wouldn't give those nice fresh eggs out for free, now would they?

OK, But Let's Make It Quick

I warn you, I'm not very good at these.

10 years ago:
Trying to make it through my surgery rotation my third year of medical school. I got home at 9pm the very first day and burst into tears as I walked through the door. And I'm not much of a weeper. I was living with an older man, a scarily ambitious member of the intelligentsia who was the most self-absorbed asshole I ever hope to meet.

1 year ago:
Doing resident interviews. And I was on call one year ago tonight.

Snacks I enjoy:

1. Jelly Bellies
2. Peanut butter, straight up
3. Chocolate ice cream with peanut butter in it
   Can't think of any more. I don't much like snacks. I like breakfast and dinner, the rest is kind of a chore.
   

Songs I know the lyrics to:

1. Itsy-Bitsy Spider
2. Senor Don Gato
   That's it. I can't remember lyrics for shit.
   

If I were a (multi-)millionaire, I would:

1. Get a house with a parking spot
2. Pay off my student loans
3. Keep a nanny on call for when HB has a fever and can't go to daycare and for occasional evenings out
4. Visit Australia and New Zealand
5. Buy a house for my brother

Bad habits:

1. Candy
2. People magazine
3. Staying up too late
4. Sleeping too late on workdays
   
5. Blogging

Things I like doing:

1. Sleeping with the baby
2. Running
3. Reading the Sunday papers while someone else runs herd on the baby
4. Blogging
5. Sitting on the patio in the summer drinking drinky-drinks

Things I'll never wear/buy again:

1. Painfully pointy shoes
2. Alpaca anything
3. Heavy earrings
4. Plastic flip-flops
5. Nightgowns

Favorite toys:

1. My mac
2. My Scion XB
3. My Zach & Dani's coffee roaster
4. My white-noise machine
5. Froogle